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          Documentation:Optimised electronic patient records to improve clinical monitoring of HIV-positive patients in rural South Africa (MONART Trial) 27 March 2020 to 30 June 2024
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          Africa Health Research Institute
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      <titlStmt>
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          AHRI.Optimised electronic patient records to improve clinical monitoring of HIV-positive patients in rural South Africa (MONART Trial) 27 March 2020 to 30 June 2024
        </titl>
        <IDNo>
          AHRI.MONART.MainStudy.2024.v1
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        <AuthEnty affiliation="AHRI, Brighton and Sussex Medical School, University of Sussex, Brightin, UK">
          Iwuji Collins
        </AuthEnty>
        <othId role="Data Manager" affiliation="Africa Health Research Institute">
          <p>
            Khumalo Sfundo
          </p>
        </othId>
        <othId role="Statistician" affiliation="Africa Health Research Institute">
          <p>
            Mazibuko Lusanda
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          Africa Health Research Institute
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        <fundAg abbr="RAEng" role="Funder">
          Royal Academy of Engineering
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      <subject>
        <keyword vocab="Africa Health Research Institute" vocabURI="www.ahri.org">
          HIV, viral load monitoring, virological failure, drug resistance, viral load champion
        </keyword>
        <topcClas vocab="Africa Health Research Institute" vocabURI="www.ahri.org">
          HIV
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      <abstract>
        <![CDATA[In our formative research, analysis of antiretroviral treatment (ART) data manually entered in the Three Interlinked Electronic Registers (TIER.Net) showed poor viral load monitoring (VLM) and inadequate management of virological failure in HIV-positive patients on ART in rural KwaZulu-Natal, South Africa. ART interruption was high, with nearly half of patients falling out of care within 5 years of starting ART. Non-Nucleoside reverse transcriptase pre-treatment drug resistance exceeds 10% in the setting; the threshold required to trigger in a change in first-line ART using the public health approach. These factors are contributory to increasing HIV drug resistance (HIVDR) in this setting. HIVDR is associated with increased morbidity and mortality with the risk of transmitting drug-resistant HIV to sexual partners. We presented these findings to healthcare providers, policy makers and community representatives with brainstorming of health system challenges and potential interventions. This study aims to complement these findings by investigating the clinical and process impediments in VLM within the health system and to develop a quality improvement package (QIP) to address the gaps. The stakeholders recommended such QIP would utilise the viral load (VL) champion model, a named healthcare provider who would be the focal point for ensuring proper administrative management of viral load tests and results through identification of those who need tests and triaging of results for action. This QIP will be supported by technological enhancement of the routine clinic-based TIER.Net software which will allow daily automatic import of results from the National Health Service Laboratory (NHLS) to TIER.Net and development of a dashboard system to support VLM. In addition, results of contact tracing will be recorded and followed up pro-actively if not initially successful.

We will evaluate the effectiveness of these interventions compared to current care for improving VLM and virological suppression using an innovative effectiveness-implementation hybrid cluster-randomised design in 10 clinics. A within-trial health economics analysis will be undertaken using recommended methods to examine the cost-effectiveness of the intervention compared to standard care. Finally, we will use a mixed-methods approach to undertake a process evaluation assessing acceptability, fidelity, adaptation and contexts in the implementation of the interventions.

Design: Cluster randomised trial of 10 primary health care clinics (5 x 2) located in the Africa Health Research Institute (AHRI) demographic surveillance area, uMkhanyakude district, South Africa.

Population and Intervention: Quality improvement package (QIP) delivered to healthcare staff including augmentation of an existing electronic ART database (TIER.Net)
Aim: We aim to demonstrate that a staff-centred QIP and technological augmentation of TIER.Net would result in optimal VLM of patients on ART, prompt clinical management of virological failure and an overall improvement in virological suppression

Objectives
1. To identify health system specific gaps in VLM.
2. To develop and train healthcare provider on a QIP using the VL champion model
3. To augment TIER.Net with a dashboard system that includes the latest laboratory results imported from the NHLS.
4. To evaluate the effectiveness of the QIP.
5. To evaluate the cost and cost effectiveness of the intervention compared to standard care
6. To undertake a process evaluation assessing acceptability, fidelity, adaptation and contexts in the implementation of the intervention.
7. To write up a best practice document, describing what is required and operationally, recommendations on how to successfully implement the QIP for a national scale-up if proven successful

Major variables: As documented in study questionnaire]]>
      </abstract>
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        <collDate date="2024-06-30" event="end"/>
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          South Africa
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        <geogCover>
          14 clinics in Hlabisa subdistrict
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        <universe>
          People living with HIV on antiretroviral therapy
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        <dataKind>
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        <citReq>
          <![CDATA[Iwuji, C. (2024). AHRI.Optimised electronic patient records to improve clinical monitoring of HIV-positive patients in rural South Africa (MONART Trial) 27 March 2020 to 30 June 2024 [Data set]. Africa Health Research Institute. 
DOI:https://doi.org/10.23664/AHRI.MONART.MAINSTUDY.2024]]>
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          Access to the data requires accurate completion of the online data access application form accessible on the AHRI Data repository(&lt;https://data.ahri.org/&gt;). Data users are required to abide by the data use conditions stipulated on the application for access to the data. Failure to do so may result in their data access privileges being revoked by the Data Custodian. In order to recognise the effort and intellectual contributions of AHRI investigators in producing and curating the data, users of AHRI data must acknowledge the source of the data and abide by the terms and conditions under which the data is accessed and must cite the dataset in publication using the citation provided as part of this documentation. All analytical datasets published on the AHRI Data Repository are assigned digital object identifier (DOIs) and the DOIs can be found on the Data Repository under Study Description tab - Access policy. AHRI data users are required to always cite the dataset using the relevant DOI.
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      </catgry>
      <varFormat type="numeric" schema="other"/>
    </var>
    <var ID="V173" name="dq_art_other" files="F6" intrvl="discrete">
      <location width="20"/>
      <labl>
        Other ART treatment in Tier
      </labl>
      <sumStat type="vald">
        68
      </sumStat>
      <sumStat type="invd">
        0
      </sumStat>
      <varFormat type="character" schema="other"/>
    </var>
    <var ID="V174" name="dq_datacollectiondate" files="F6" dcml="0" intrvl="contin">
      <location width="11"/>
      <labl>
        Date of data Collection:
      </labl>
      <valrng>
        <range UNITS="REAL" min="2004428833000" max="2034753388000"/>
      </valrng>
      <sumStat type="vald">
        4188
      </sumStat>
      <sumStat type="invd">
        12
      </sumStat>
      <sumStat type="min">
        2004428833000
      </sumStat>
      <sumStat type="max">
        2034753388000
      </sumStat>
      <sumStat type="mean">
        2020261688579.75
      </sumStat>
      <sumStat type="stdev">
        10621686290.56
      </sumStat>
      <varFormat type="numeric" schema="other"/>
    </var>
    <var ID="V175" name="dq_vl1date" files="F6" intrvl="discrete">
      <location width="11"/>
      <labl>
        Date of VL1 test
      </labl>
      <sumStat type="vald">
        3370
      </sumStat>
      <sumStat type="min">
        2021-12-09
      </sumStat>
      <sumStat type="max">
        2024-06-20
      </sumStat>
      <varFormat type="character" formatname="Nesstar.date" schema="other" category="date"/>
    </var>
    <var ID="V176" name="dq_vl1result" files="F6" dcml="0" intrvl="contin">
      <location width="12"/>
      <labl>
        What is the result of VL1?
      </labl>
      <valrng>
        <range UNITS="REAL" min="18" max="3460000"/>
      </valrng>
      <sumStat type="vald">
        3369
      </sumStat>
      <sumStat type="invd">
        831
      </sumStat>
      <sumStat type="min">
        18
      </sumStat>
      <sumStat type="max">
        3460000
      </sumStat>
      <sumStat type="mean">
        3801.638
      </sumStat>
      <sumStat type="stdev">
        77935.282
      </sumStat>
      <varFormat type="numeric" schema="other"/>
    </var>
    <var ID="V177" name="dq_vl_other_1" files="F6" dcml="0" intrvl="discrete">
      <location width="8"/>
      <labl>
        Are there other VL documented in Tier
      </labl>
      <valrng>
        <range UNITS="REAL" min="1" max="2"/>
      </valrng>
      <sumStat type="vald">
        3365
      </sumStat>
      <sumStat type="invd">
        835
      </sumStat>
      <catgry>
        <catValu>
          1
        </catValu>
        <labl>
          Yes
        </labl>
        <catStat type="freq">
          881
        </catStat>
      </catgry>
      <catgry>
        <catValu>
          2
        </catValu>
        <labl>
          No
        </labl>
        <catStat type="freq">
          2484
        </catStat>
      </catgry>
      <catgry missing="Y">
        <catValu>
          Sysmiss
        </catValu>
        <catStat type="freq">
          835
        </catStat>
      </catgry>
      <varFormat type="numeric" schema="other"/>
    </var>
    <var ID="V178" name="dq_vl2date" files="F6" intrvl="discrete">
      <location width="11"/>
      <labl>
        Date of VL2 test:
      </labl>
      <sumStat type="vald">
        881
      </sumStat>
      <sumStat type="min">
        2021-12-09
      </sumStat>
      <sumStat type="max">
        2024-05-30
      </sumStat>
      <varFormat type="character" formatname="Nesstar.date" schema="other" category="date"/>
    </var>
    <var ID="V179" name="dq_vl2results" files="F6" dcml="0" intrvl="contin">
      <location width="12"/>
      <labl>
        What is the result of VL2?
      </labl>
      <valrng>
        <range UNITS="REAL" min="19" max="3770000"/>
      </valrng>
      <sumStat type="vald">
        880
      </sumStat>
      <sumStat type="invd">
        3320
      </sumStat>
      <sumStat type="min">
        19
      </sumStat>
      <sumStat type="max">
        3770000
      </sumStat>
      <sumStat type="mean">
        7931.638
      </sumStat>
      <sumStat type="stdev">
        130492.253
      </sumStat>
      <varFormat type="numeric" schema="other"/>
    </var>
    <var ID="V180" name="dq_vl_other_2" files="F6" dcml="0" intrvl="discrete">
      <location width="8"/>
      <labl>
        Are there other VL documented in Chart
      </labl>
      <valrng>
        <range UNITS="REAL" min="1" max="2"/>
      </valrng>
      <sumStat type="vald">
        876
      </sumStat>
      <sumStat type="invd">
        3324
      </sumStat>
      <catgry>
        <catValu>
          1
        </catValu>
        <labl>
          Yes
        </labl>
        <catStat type="freq">
          142
        </catStat>
      </catgry>
      <catgry>
        <catValu>
          2
        </catValu>
        <labl>
          No
        </labl>
        <catStat type="freq">
          734
        </catStat>
      </catgry>
      <catgry missing="Y">
        <catValu>
          Sysmiss
        </catValu>
        <catStat type="freq">
          3324
        </catStat>
      </catgry>
      <varFormat type="numeric" schema="other"/>
    </var>
    <var ID="V181" name="dq_vl3date" files="F6" intrvl="discrete">
      <location width="11"/>
      <labl>
        Date of VL3:
      </labl>
      <sumStat type="vald">
        142
      </sumStat>
      <sumStat type="min">
        2021-12-29
      </sumStat>
      <sumStat type="max">
        2024-02-02
      </sumStat>
      <varFormat type="character" formatname="Nesstar.date" schema="other" category="date"/>
    </var>
    <var ID="V182" name="dq_vl3results" files="F6" dcml="0" intrvl="contin">
      <location width="12"/>
      <labl>
        What is the result of VL3?
      </labl>
      <valrng>
        <range UNITS="REAL" min="19" max="591000"/>
      </valrng>
      <sumStat type="vald">
        141
      </sumStat>
      <sumStat type="invd">
        4059
      </sumStat>
      <sumStat type="min">
        19
      </sumStat>
      <sumStat type="max">
        591000
      </sumStat>
      <sumStat type="mean">
        16425.489
      </sumStat>
      <sumStat type="stdev">
        77691.475
      </sumStat>
      <varFormat type="numeric" schema="other"/>
    </var>
    <var ID="V183" name="dq_vl_other_3" files="F6" dcml="0" intrvl="discrete">
      <location width="8"/>
      <labl>
        Are there other VL documented in Chart
      </labl>
      <valrng>
        <range UNITS="REAL" min="1" max="2"/>
      </valrng>
      <sumStat type="vald">
        141
      </sumStat>
      <sumStat type="invd">
        4059
      </sumStat>
      <catgry>
        <catValu>
          1
        </catValu>
        <labl>
          Yes
        </labl>
        <catStat type="freq">
          22
        </catStat>
      </catgry>
      <catgry>
        <catValu>
          2
        </catValu>
        <labl>
          No
        </labl>
        <catStat type="freq">
          119
        </catStat>
      </catgry>
      <catgry missing="Y">
        <catValu>
          Sysmiss
        </catValu>
        <catStat type="freq">
          4059
        </catStat>
      </catgry>
      <varFormat type="numeric" schema="other"/>
    </var>
    <var ID="V184" name="dq_vl4date" files="F6" intrvl="discrete">
      <location width="11"/>
      <labl>
        Date of VL4:
      </labl>
      <sumStat type="vald">
        22
      </sumStat>
      <sumStat type="min">
        2021-12-10
      </sumStat>
      <sumStat type="max">
        2022-09-14
      </sumStat>
      <varFormat type="character" formatname="Nesstar.date" schema="other" category="date"/>
    </var>
    <var ID="V185" name="dq_vl4results" files="F6" dcml="0" intrvl="contin">
      <location width="12"/>
      <labl>
        What is the result of VL4?
      </labl>
      <valrng>
        <range UNITS="REAL" min="19" max="375000"/>
      </valrng>
      <sumStat type="vald">
        22
      </sumStat>
      <sumStat type="invd">
        4178
      </sumStat>
      <sumStat type="min">
        19
      </sumStat>
      <sumStat type="max">
        375000
      </sumStat>
      <sumStat type="mean">
        37101.545
      </sumStat>
      <sumStat type="stdev">
        108449.834
      </sumStat>
      <varFormat type="numeric" schema="other"/>
    </var>
    <var ID="V186" name="dq_vl_other_4" files="F6" dcml="0" intrvl="discrete">
      <location width="8"/>
      <labl>
        Are there other VL documented in Chart
      </labl>
      <valrng>
        <range UNITS="REAL" min="1" max="2"/>
      </valrng>
      <sumStat type="vald">
        22
      </sumStat>
      <sumStat type="invd">
        4178
      </sumStat>
      <catgry>
        <catValu>
          1
        </catValu>
        <labl>
          Yes
        </labl>
        <catStat type="freq">
          6
        </catStat>
      </catgry>
      <catgry>
        <catValu>
          2
        </catValu>
        <labl>
          No
        </labl>
        <catStat type="freq">
          16
        </catStat>
      </catgry>
      <catgry missing="Y">
        <catValu>
          Sysmiss
        </catValu>
        <catStat type="freq">
          4178
        </catStat>
      </catgry>
      <varFormat type="numeric" schema="other"/>
    </var>
    <var ID="V187" name="dq_vl5date" files="F6" intrvl="discrete">
      <location width="11"/>
      <labl>
        Date of VL5:
      </labl>
      <sumStat type="vald">
        6
      </sumStat>
      <sumStat type="min">
        2022-01-06
      </sumStat>
      <sumStat type="max">
        2022-06-27
      </sumStat>
      <varFormat type="character" formatname="Nesstar.date" schema="other" category="date"/>
    </var>
    <var ID="V188" name="dq_vl5results" files="F6" dcml="0" intrvl="contin">
      <location width="12"/>
      <labl>
        What is the result of VL5?
      </labl>
      <valrng>
        <range UNITS="REAL" min="19" max="310000"/>
      </valrng>
      <sumStat type="vald">
        6
      </sumStat>
      <sumStat type="invd">
        4194
      </sumStat>
      <sumStat type="min">
        19
      </sumStat>
      <sumStat type="max">
        310000
      </sumStat>
      <sumStat type="mean">
        77365
      </sumStat>
      <sumStat type="stdev">
        119844.858
      </sumStat>
      <varFormat type="numeric" schema="other"/>
    </var>
    <var ID="V189" name="data_extraction_ques_v_0" files="F6" dcml="0" intrvl="discrete">
      <location width="10"/>
      <labl>
        Complete?
      </labl>
      <valrng>
        <range UNITS="REAL" min="0" max="2"/>
      </valrng>
      <sumStat type="vald">
        4200
      </sumStat>
      <sumStat type="invd">
        0
      </sumStat>
      <catgry>
        <catValu>
          0
        </catValu>
        <labl>
          Incomplete
        </labl>
        <catStat type="freq">
          0
        </catStat>
      </catgry>
      <catgry>
        <catValu>
          1
        </catValu>
        <labl>
          Unverified
        </labl>
        <catStat type="freq">
          0
        </catStat>
      </catgry>
      <catgry>
        <catValu>
          2
        </catValu>
        <labl>
          Complete
        </labl>
        <catStat type="freq">
          4200
        </catStat>
      </catgry>
      <varFormat type="numeric" schema="other"/>
    </var>
    <var ID="V190" name="dqc_start_datechart_rev" files="F6" intrvl="discrete">
      <location width="11"/>
      <labl>
        Start date of chart review (calculated automatically bysubtracting 15 months fro
      </labl>
      <sumStat type="vald">
        4200
      </sumStat>
      <sumStat type="min">
        2021-12-01
      </sumStat>
      <sumStat type="max">
        2022-03-02
      </sumStat>
      <varFormat type="character" formatname="Nesstar.date" schema="other" category="date"/>
    </var>
    <var ID="V191" name="dqc_missingfile" files="F6" dcml="0" intrvl="discrete">
      <location width="8"/>
      <labl>
        Is the clinical chart missing?
      </labl>
      <valrng>
        <range UNITS="REAL" min="1" max="2"/>
      </valrng>
      <sumStat type="vald">
        4199
      </sumStat>
      <sumStat type="invd">
        1
      </sumStat>
      <catgry>
        <catValu>
          1
        </catValu>
        <labl>
          Yes
        </labl>
        <catStat type="freq">
          586
        </catStat>
      </catgry>
      <catgry>
        <catValu>
          2
        </catValu>
        <labl>
          No
        </labl>
        <catStat type="freq">
          3613
        </catStat>
      </catgry>
      <catgry missing="Y">
        <catValu>
          Sysmiss
        </catValu>
        <catStat type="freq">
          1
        </catStat>
      </catgry>
      <varFormat type="numeric" schema="other"/>
    </var>
    <var ID="V192" name="dqc_outcome_yn" files="F6" dcml="0" intrvl="discrete">
      <location width="8"/>
      <labl>
        Is there an outcome?
      </labl>
      <valrng>
        <range UNITS="REAL" min="1" max="2"/>
      </valrng>
      <sumStat type="vald">
        2047
      </sumStat>
      <sumStat type="invd">
        2153
      </sumStat>
      <catgry>
        <catValu>
          1
        </catValu>
        <labl>
          Yes
        </labl>
        <catStat type="freq">
          18
        </catStat>
      </catgry>
      <catgry>
        <catValu>
          2
        </catValu>
        <labl>
          No
        </labl>
        <catStat type="freq">
          2029
        </catStat>
      </catgry>
      <catgry missing="Y">
        <catValu>
          Sysmiss
        </catValu>
        <catStat type="freq">
          2153
        </catStat>
      </catgry>
      <varFormat type="numeric" schema="other"/>
    </var>
    <var ID="V193" name="dqc_outcome_2" files="F6" dcml="0" intrvl="discrete">
      <location width="14"/>
      <labl>
        What is an outcome?
      </labl>
      <valrng>
        <range UNITS="REAL" min="1" max="3"/>
      </valrng>
      <sumStat type="vald">
        18
      </sumStat>
      <sumStat type="invd">
        4182
      </sumStat>
      <catgry>
        <catValu>
          1
        </catValu>
        <labl>
          Transfer Out
        </labl>
        <catStat type="freq">
          13
        </catStat>
      </catgry>
      <catgry>
        <catValu>
          2
        </catValu>
        <labl>
          Lost To Follow
        </labl>
        <catStat type="freq">
          2
        </catStat>
      </catgry>
      <catgry>
        <catValu>
          3
        </catValu>
        <labl>
          Death
        </labl>
        <catStat type="freq">
          3
        </catStat>
      </catgry>
      <catgry missing="Y">
        <catValu>
          Sysmiss
        </catValu>
        <catStat type="freq">
          4182
        </catStat>
      </catgry>
      <varFormat type="numeric" schema="other"/>
    </var>
    <var ID="V194" name="dq_outcome_date_2" files="F6" dcml="0" intrvl="contin">
      <location width="11"/>
      <labl>
        Date of [dqc_outcome_2]
      </labl>
      <valrng>
        <range UNITS="REAL" min="1915182507000" max="2031135807000"/>
      </valrng>
      <sumStat type="vald">
        18
      </sumStat>
      <sumStat type="invd">
        4182
      </sumStat>
      <sumStat type="min">
        1915182507000
      </sumStat>
      <sumStat type="max">
        2031135807000
      </sumStat>
      <sumStat type="mean">
        2012695498000
      </sumStat>
      <sumStat type="stdev">
        25564590323.194
      </sumStat>
      <varFormat type="numeric" schema="other"/>
    </var>
    <var ID="V195" name="dqc_art_code_chart" files="F6" dcml="0" intrvl="discrete">
      <location width="67"/>
      <labl>
        ART treatment code in Chart
      </labl>
      <valrng>
        <range UNITS="REAL" min="1" max="95"/>
      </valrng>
      <sumStat type="vald">
        3606
      </sumStat>
      <sumStat type="invd">
        594
      </sumStat>
      <catgry>
        <catValu>
          1
        </catValu>
        <labl>
          TDF (Tenofovir)+3TC (Lamuvidine)+DTG (Dolutegravir) = 1T30
        </labl>
        <catStat type="freq">
          3459
        </catStat>
      </catgry>
      <catgry>
        <catValu>
          2
        </catValu>
        <labl>
          TDF( Tenofovir)+3TC (Lamuvidine)+EFV (Efavirenz) = 1T3E
        </labl>
        <catStat type="freq">
          46
        </catStat>
      </catgry>
      <catgry>
        <catValu>
          3
        </catValu>
        <labl>
          TDF (Tenofovir)+FTC (Emtricitabine)+EFV (Efavirenz) = 1TFE
        </labl>
        <catStat type="freq">
          42
        </catStat>
      </catgry>
      <catgry>
        <catValu>
          4
        </catValu>
        <labl>
          AZT (Zidovudine)+3TC (Lamuvidine)+EFV (Efavirenz) = 1Z3E
        </labl>
        <catStat type="freq">
          5
        </catStat>
      </catgry>
      <catgry>
        <catValu>
          5
        </catValu>
        <labl>
          ABC (Abacavir)+3TC (Lamuvidine)+EFV (Efavirenz) = 1A3E
        </labl>
        <catStat type="freq">
          4
        </catStat>
      </catgry>
      <catgry>
        <catValu>
          6
        </catValu>
        <labl>
          AZT (Zidovudine)+3TC (Lamuvidine)+LPV/r (Lopinavir/Ritonavir)= 1Z3L
        </labl>
        <catStat type="freq">
          11
        </catStat>
      </catgry>
      <catgry>
        <catValu>
          7
        </catValu>
        <labl>
          ABC (Abacavir)+3TC (Lamuvidine)+LPV/r (Lopinavir/Ritonavir)= 1Z3L
        </labl>
        <catStat type="freq">
          2
        </catStat>
      </catgry>
      <catgry>
        <catValu>
          95
        </catValu>
        <labl>
          Other
        </labl>
        <catStat type="freq">
          37
        </catStat>
      </catgry>
      <catgry missing="Y">
        <catValu>
          Sysmiss
        </catValu>
        <catStat type="freq">
          594
        </catStat>
      </catgry>
      <varFormat type="numeric" schema="other"/>
    </var>
    <var ID="V196" name="dqc_art_other" files="F6" intrvl="discrete">
      <location width="31"/>
      <labl>
        Other ART treatment in Chart
      </labl>
      <sumStat type="vald">
        37
      </sumStat>
      <sumStat type="invd">
        0
      </sumStat>
      <varFormat type="character" schema="other"/>
    </var>
    <var ID="V197" name="dqc_datacollectiondate" files="F6" dcml="0" intrvl="contin">
      <location width="11"/>
      <labl>
        Date of data Collection:
      </labl>
      <valrng>
        <range UNITS="REAL" min="2004078883000" max="2036735092000"/>
      </valrng>
      <sumStat type="vald">
        4199
      </sumStat>
      <sumStat type="invd">
        1
      </sumStat>
      <sumStat type="min">
        2004078883000
      </sumStat>
      <sumStat type="max">
        2036735092000
      </sumStat>
      <sumStat type="mean">
        2018615642793.05
      </sumStat>
      <sumStat type="stdev">
        13406266531.443
      </sumStat>
      <varFormat type="numeric" schema="other"/>
    </var>
    <var ID="V198" name="dqc_wastherevl1measure" files="F6" dcml="0" intrvl="discrete">
      <location width="8"/>
      <labl>
        Is there an evidence of VL1 blood test request documented on chart?
      </labl>
      <valrng>
        <range UNITS="REAL" min="1" max="2"/>
      </valrng>
      <sumStat type="vald">
        3602
      </sumStat>
      <sumStat type="invd">
        598
      </sumStat>
      <catgry>
        <catValu>
          1
        </catValu>
        <labl>
          Yes
        </labl>
        <catStat type="freq">
          2610
        </catStat>
      </catgry>
      <catgry>
        <catValu>
          2
        </catValu>
        <labl>
          No
        </labl>
        <catStat type="freq">
          992
        </catStat>
      </catgry>
      <catgry missing="Y">
        <catValu>
          Sysmiss
        </catValu>
        <catStat type="freq">
          598
        </catStat>
      </catgry>
      <varFormat type="numeric" schema="other"/>
    </var>
    <var ID="V199" name="dqc_vl1date" files="F6" intrvl="discrete">
      <location width="11"/>
      <labl>
        Date of VL1 test
      </labl>
      <sumStat type="vald">
        3020
      </sumStat>
      <sumStat type="min">
        2021-12-13
      </sumStat>
      <sumStat type="max">
        2024-06-18
      </sumStat>
      <varFormat type="character" formatname="Nesstar.date" schema="other" category="date"/>
    </var>
    <var ID="V200" name="dqc_vl1resultavailable" files="F6" dcml="0" intrvl="discrete">
      <location width="8"/>
      <labl>
        Is VL1 result written in the chart?
      </labl>
      <valrng>
        <range UNITS="REAL" min="1" max="2"/>
      </valrng>
      <sumStat type="vald">
        3598
      </sumStat>
      <sumStat type="invd">
        602
      </sumStat>
      <catgry>
        <catValu>
          1
        </catValu>
        <labl>
          Yes
        </labl>
        <catStat type="freq">
          574
        </catStat>
      </catgry>
      <catgry>
        <catValu>
          2
        </catValu>
        <labl>
          No
        </labl>
        <catStat type="freq">
          3024
        </catStat>
      </catgry>
      <catgry missing="Y">
        <catValu>
          Sysmiss
        </catValu>
        <catStat type="freq">
          602
        </catStat>
      </catgry>
      <varFormat type="numeric" schema="other"/>
    </var>
    <var ID="V201" name="dqc_vl1result" files="F6" dcml="0" intrvl="contin">
      <location width="12"/>
      <labl>
        What is the result of VL1?
      </labl>
      <valrng>
        <range UNITS="REAL" min="0" max="1890000"/>
      </valrng>
      <sumStat type="vald">
        2564
      </sumStat>
      <sumStat type="invd">
        1636
      </sumStat>
      <sumStat type="min">
        0
      </sumStat>
      <sumStat type="max">
        1890000
      </sumStat>
      <sumStat type="mean">
        1621.837
      </sumStat>
      <sumStat type="stdev">
        39696.126
      </sumStat>
      <varFormat type="numeric" schema="other"/>
    </var>
    <var ID="V202" name="dqc_vl1labcopy" files="F6" dcml="0" intrvl="discrete">
      <location width="8"/>
      <labl>
        Lab copy of VL1 filed in chart:
      </labl>
      <valrng>
        <range UNITS="REAL" min="1" max="2"/>
      </valrng>
      <sumStat type="vald">
        3611
      </sumStat>
      <sumStat type="invd">
        589
      </sumStat>
      <catgry>
        <catValu>
          1
        </catValu>
        <labl>
          Yes
        </labl>
        <catStat type="freq">
          2433
        </catStat>
      </catgry>
      <catgry>
        <catValu>
          2
        </catValu>
        <labl>
          No
        </labl>
        <catStat type="freq">
          1178
        </catStat>
      </catgry>
      <catgry missing="Y">
        <catValu>
          Sysmiss
        </catValu>
        <catStat type="freq">
          589
        </catStat>
      </catgry>
      <varFormat type="numeric" schema="other"/>
    </var>
    <var ID="V203" name="dq_vl_other_1_v2" files="F6" dcml="0" intrvl="discrete">
      <location width="8"/>
      <labl>
        Are there other VL documented in Chart
      </labl>
      <valrng>
        <range UNITS="REAL" min="1" max="2"/>
      </valrng>
      <sumStat type="vald">
        3603
      </sumStat>
      <sumStat type="invd">
        597
      </sumStat>
      <catgry>
        <catValu>
          1
        </catValu>
        <labl>
          Yes
        </labl>
        <catStat type="freq">
          650
        </catStat>
      </catgry>
      <catgry>
        <catValu>
          2
        </catValu>
        <labl>
          No
        </labl>
        <catStat type="freq">
          2953
        </catStat>
      </catgry>
      <catgry missing="Y">
        <catValu>
          Sysmiss
        </catValu>
        <catStat type="freq">
          597
        </catStat>
      </catgry>
      <varFormat type="numeric" schema="other"/>
    </var>
    <var ID="V204" name="dqc_wastherevl2measure" files="F6" dcml="0" intrvl="discrete">
      <location width="8"/>
      <labl>
        Is there an evidence of VL2 blood test request documented on chart?
      </labl>
      <valrng>
        <range UNITS="REAL" min="1" max="2"/>
      </valrng>
      <sumStat type="vald">
        649
      </sumStat>
      <sumStat type="invd">
        3551
      </sumStat>
      <catgry>
        <catValu>
          1
        </catValu>
        <labl>
          Yes
        </labl>
        <catStat type="freq">
          571
        </catStat>
      </catgry>
      <catgry>
        <catValu>
          2
        </catValu>
        <labl>
          No
        </labl>
        <catStat type="freq">
          78
        </catStat>
      </catgry>
      <catgry missing="Y">
        <catValu>
          Sysmiss
        </catValu>
        <catStat type="freq">
          3551
        </catStat>
      </catgry>
      <varFormat type="numeric" schema="other"/>
    </var>
    <var ID="V205" name="dqc_vl2date" files="F6" intrvl="discrete">
      <location width="11"/>
      <labl>
        Date of VL2 test:
      </labl>
      <sumStat type="vald">
        649
      </sumStat>
      <sumStat type="min">
        2021-12-09
      </sumStat>
      <sumStat type="max">
        2024-05-28
      </sumStat>
      <varFormat type="character" formatname="Nesstar.date" schema="other" category="date"/>
    </var>
    <var ID="V206" name="dqc_vl2resultavailable" files="F6" dcml="0" intrvl="discrete">
      <location width="8"/>
      <labl>
        Is VL2 result written in the chart?
      </labl>
      <valrng>
        <range UNITS="REAL" min="1" max="2"/>
      </valrng>
      <sumStat type="vald">
        648
      </sumStat>
      <sumStat type="invd">
        3552
      </sumStat>
      <catgry>
        <catValu>
          1
        </catValu>
        <labl>
          Yes
        </labl>
        <catStat type="freq">
          81
        </catStat>
      </catgry>
      <catgry>
        <catValu>
          2
        </catValu>
        <labl>
          No
        </labl>
        <catStat type="freq">
          567
        </catStat>
      </catgry>
      <catgry missing="Y">
        <catValu>
          Sysmiss
        </catValu>
        <catStat type="freq">
          3552
        </catStat>
      </catgry>
      <varFormat type="numeric" schema="other"/>
    </var>
    <var ID="V207" name="dqc_vl2results" files="F6" dcml="0" intrvl="contin">
      <location width="12"/>
      <labl>
        What is the result of VL2?
      </labl>
      <valrng>
        <range UNITS="REAL" min="0" max="1620000"/>
      </valrng>
      <sumStat type="vald">
        585
      </sumStat>
      <sumStat type="invd">
        3615
      </sumStat>
      <sumStat type="min">
        0
      </sumStat>
      <sumStat type="max">
        1620000
      </sumStat>
      <sumStat type="mean">
        4726.588
      </sumStat>
      <sumStat type="stdev">
        68600.742
      </sumStat>
      <varFormat type="numeric" schema="other"/>
    </var>
    <var ID="V208" name="dqc_vl2labcopy" files="F6" dcml="0" intrvl="discrete">
      <location width="8"/>
      <labl>
        Lab copy of VL2 filed in chart:
      </labl>
      <valrng>
        <range UNITS="REAL" min="1" max="2"/>
      </valrng>
      <sumStat type="vald">
        652
      </sumStat>
      <sumStat type="invd">
        3548
      </sumStat>
      <catgry>
        <catValu>
          1
        </catValu>
        <labl>
          Yes
        </labl>
        <catStat type="freq">
          571
        </catStat>
      </catgry>
      <catgry>
        <catValu>
          2
        </catValu>
        <labl>
          No
        </labl>
        <catStat type="freq">
          81
        </catStat>
      </catgry>
      <catgry missing="Y">
        <catValu>
          Sysmiss
        </catValu>
        <catStat type="freq">
          3548
        </catStat>
      </catgry>
      <varFormat type="numeric" schema="other"/>
    </var>
    <var ID="V209" name="dq_vl_other_2_v2" files="F6" dcml="0" intrvl="discrete">
      <location width="8"/>
      <labl>
        Are there other VL documented in Chart
      </labl>
      <valrng>
        <range UNITS="REAL" min="1" max="2"/>
      </valrng>
      <sumStat type="vald">
        652
      </sumStat>
      <sumStat type="invd">
        3548
      </sumStat>
      <catgry>
        <catValu>
          1
        </catValu>
        <labl>
          Yes
        </labl>
        <catStat type="freq">
          79
        </catStat>
      </catgry>
      <catgry>
        <catValu>
          2
        </catValu>
        <labl>
          No
        </labl>
        <catStat type="freq">
          573
        </catStat>
      </catgry>
      <catgry missing="Y">
        <catValu>
          Sysmiss
        </catValu>
        <catStat type="freq">
          3548
        </catStat>
      </catgry>
      <varFormat type="numeric" schema="other"/>
    </var>
    <var ID="V210" name="dqc_wastherevl3measure" files="F6" dcml="0" intrvl="discrete">
      <location width="8"/>
      <labl>
        Is there an evidence of VL3 blood test request documented on chart?
      </labl>
      <valrng>
        <range UNITS="REAL" min="1" max="2"/>
      </valrng>
      <sumStat type="vald">
        80
      </sumStat>
      <sumStat type="invd">
        4120
      </sumStat>
      <catgry>
        <catValu>
          1
        </catValu>
        <labl>
          Yes
        </labl>
        <catStat type="freq">
          68
        </catStat>
      </catgry>
      <catgry>
        <catValu>
          2
        </catValu>
        <labl>
          No
        </labl>
        <catStat type="freq">
          12
        </catStat>
      </catgry>
      <catgry missing="Y">
        <catValu>
          Sysmiss
        </catValu>
        <catStat type="freq">
          4120
        </catStat>
      </catgry>
      <varFormat type="numeric" schema="other"/>
    </var>
    <var ID="V211" name="dqc_vl3date" files="F6" intrvl="discrete">
      <location width="11"/>
      <labl>
        Date of VL3:
      </labl>
      <sumStat type="vald">
        79
      </sumStat>
      <sumStat type="min">
        2020-07-08
      </sumStat>
      <sumStat type="max">
        2024-04-26
      </sumStat>
      <varFormat type="character" formatname="Nesstar.date" schema="other" category="date"/>
    </var>
    <var ID="V212" name="dqc_vl3resultavailable" files="F6" dcml="0" intrvl="discrete">
      <location width="8"/>
      <labl>
        Is VL3 result written in the chart?
      </labl>
      <valrng>
        <range UNITS="REAL" min="1" max="2"/>
      </valrng>
      <sumStat type="vald">
        79
      </sumStat>
      <sumStat type="invd">
        4121
      </sumStat>
      <catgry>
        <catValu>
          1
        </catValu>
        <labl>
          Yes
        </labl>
        <catStat type="freq">
          12
        </catStat>
      </catgry>
      <catgry>
        <catValu>
          2
        </catValu>
        <labl>
          No
        </labl>
        <catStat type="freq">
          67
        </catStat>
      </catgry>
      <catgry missing="Y">
        <catValu>
          Sysmiss
        </catValu>
        <catStat type="freq">
          4121
        </catStat>
      </catgry>
      <varFormat type="numeric" schema="other"/>
    </var>
    <var ID="V213" name="dqc_vl3results" files="F6" dcml="0" intrvl="contin">
      <location width="12"/>
      <labl>
        What is the result of VL3?
      </labl>
      <valrng>
        <range UNITS="REAL" min="0" max="375000"/>
      </valrng>
      <sumStat type="vald">
        75
      </sumStat>
      <sumStat type="invd">
        4125
      </sumStat>
      <sumStat type="min">
        0
      </sumStat>
      <sumStat type="max">
        375000
      </sumStat>
      <sumStat type="mean">
        9286.987
      </sumStat>
      <sumStat type="stdev">
        46287.875
      </sumStat>
      <varFormat type="numeric" schema="other"/>
    </var>
    <var ID="V214" name="dqc_vl3labcopy" files="F6" dcml="0" intrvl="discrete">
      <location width="8"/>
      <labl>
        Lab copy of VL3 filed in chart:
      </labl>
      <valrng>
        <range UNITS="REAL" min="1" max="2"/>
      </valrng>
      <sumStat type="vald">
        79
      </sumStat>
      <sumStat type="invd">
        4121
      </sumStat>
      <catgry>
        <catValu>
          1
        </catValu>
        <labl>
          Yes
        </labl>
        <catStat type="freq">
          76
        </catStat>
      </catgry>
      <catgry>
        <catValu>
          2
        </catValu>
        <labl>
          No
        </labl>
        <catStat type="freq">
          3
        </catStat>
      </catgry>
      <catgry missing="Y">
        <catValu>
          Sysmiss
        </catValu>
        <catStat type="freq">
          4121
        </catStat>
      </catgry>
      <varFormat type="numeric" schema="other"/>
    </var>
    <var ID="V215" name="dq_vl_other_3_v2" files="F6" dcml="0" intrvl="discrete">
      <location width="8"/>
      <labl>
        Are there other VL documented in Chart
      </labl>
      <valrng>
        <range UNITS="REAL" min="1" max="2"/>
      </valrng>
      <sumStat type="vald">
        78
      </sumStat>
      <sumStat type="invd">
        4122
      </sumStat>
      <catgry>
        <catValu>
          1
        </catValu>
        <labl>
          Yes
        </labl>
        <catStat type="freq">
          9
        </catStat>
      </catgry>
      <catgry>
        <catValu>
          2
        </catValu>
        <labl>
          No
        </labl>
        <catStat type="freq">
          69
        </catStat>
      </catgry>
      <catgry missing="Y">
        <catValu>
          Sysmiss
        </catValu>
        <catStat type="freq">
          4122
        </catStat>
      </catgry>
      <varFormat type="numeric" schema="other"/>
    </var>
    <var ID="V216" name="dqc_wastherevl4measure" files="F6" dcml="0" intrvl="discrete">
      <location width="8"/>
      <labl>
        Is there an evidence of VL4 blood test request documented on chart?
      </labl>
      <valrng>
        <range UNITS="REAL" min="1" max="2"/>
      </valrng>
      <sumStat type="vald">
        9
      </sumStat>
      <sumStat type="invd">
        4191
      </sumStat>
      <catgry>
        <catValu>
          1
        </catValu>
        <labl>
          Yes
        </labl>
        <catStat type="freq">
          8
        </catStat>
      </catgry>
      <catgry>
        <catValu>
          2
        </catValu>
        <labl>
          No
        </labl>
        <catStat type="freq">
          1
        </catStat>
      </catgry>
      <catgry missing="Y">
        <catValu>
          Sysmiss
        </catValu>
        <catStat type="freq">
          4191
        </catStat>
      </catgry>
      <varFormat type="numeric" schema="other"/>
    </var>
    <var ID="V217" name="dqc_vl4date" files="F6" intrvl="discrete">
      <location width="11"/>
      <labl>
        Date of VL4:
      </labl>
      <sumStat type="vald">
        9
      </sumStat>
      <sumStat type="min">
        2022-01-06
      </sumStat>
      <sumStat type="max">
        2023-09-18
      </sumStat>
      <varFormat type="character" formatname="Nesstar.date" schema="other" category="date"/>
    </var>
    <var ID="V218" name="dqc_vl4resultavailable" files="F6" dcml="0" intrvl="discrete">
      <location width="8"/>
      <labl>
        Is VL4 result written in the chart?
      </labl>
      <valrng>
        <range UNITS="REAL" min="1" max="2"/>
      </valrng>
      <sumStat type="vald">
        8
      </sumStat>
      <sumStat type="invd">
        4192
      </sumStat>
      <catgry>
        <catValu>
          1
        </catValu>
        <labl>
          Yes
        </labl>
        <catStat type="freq">
          3
        </catStat>
      </catgry>
      <catgry>
        <catValu>
          2
        </catValu>
        <labl>
          No
        </labl>
        <catStat type="freq">
          5
        </catStat>
      </catgry>
      <catgry missing="Y">
        <catValu>
          Sysmiss
        </catValu>
        <catStat type="freq">
          4192
        </catStat>
      </catgry>
      <varFormat type="numeric" schema="other"/>
    </var>
    <var ID="V219" name="dq_vl4results_v2" files="F6" dcml="0" intrvl="contin">
      <location width="12"/>
      <labl>
        What is the result of VL4?
      </labl>
      <valrng>
        <range UNITS="REAL" min="19" max="310000"/>
      </valrng>
      <sumStat type="vald">
        9
      </sumStat>
      <sumStat type="invd">
        4191
      </sumStat>
      <sumStat type="min">
        19
      </sumStat>
      <sumStat type="max">
        310000
      </sumStat>
      <sumStat type="mean">
        39821.556
      </sumStat>
      <sumStat type="stdev">
        101874.508
      </sumStat>
      <varFormat type="numeric" schema="other"/>
    </var>
    <var ID="V220" name="dqc_vl4labcopy" files="F6" dcml="0" intrvl="discrete">
      <location width="8"/>
      <labl>
        Lab copy of VL4 filed in chart:
      </labl>
      <valrng>
        <range UNITS="REAL" min="1" max="2"/>
      </valrng>
      <sumStat type="vald">
        9
      </sumStat>
      <sumStat type="invd">
        4191
      </sumStat>
      <catgry>
        <catValu>
          1
        </catValu>
        <labl>
          Yes
        </labl>
        <catStat type="freq">
          8
        </catStat>
      </catgry>
      <catgry>
        <catValu>
          2
        </catValu>
        <labl>
          No
        </labl>
        <catStat type="freq">
          1
        </catStat>
      </catgry>
      <catgry missing="Y">
        <catValu>
          Sysmiss
        </catValu>
        <catStat type="freq">
          4191
        </catStat>
      </catgry>
      <varFormat type="numeric" schema="other"/>
    </var>
    <var ID="V221" name="dq_vl_other_4_v2" files="F6" dcml="0" intrvl="discrete">
      <location width="8"/>
      <labl>
        Are there other VL documented in Chart
      </labl>
      <valrng>
        <range UNITS="REAL" min="1" max="2"/>
      </valrng>
      <sumStat type="vald">
        9
      </sumStat>
      <sumStat type="invd">
        4191
      </sumStat>
      <catgry>
        <catValu>
          1
        </catValu>
        <labl>
          Yes
        </labl>
        <catStat type="freq">
          2
        </catStat>
      </catgry>
      <catgry>
        <catValu>
          2
        </catValu>
        <labl>
          No
        </labl>
        <catStat type="freq">
          7
        </catStat>
      </catgry>
      <catgry missing="Y">
        <catValu>
          Sysmiss
        </catValu>
        <catStat type="freq">
          4191
        </catStat>
      </catgry>
      <varFormat type="numeric" schema="other"/>
    </var>
    <var ID="V222" name="dqc_wastherevl5measure" files="F6" dcml="0" intrvl="discrete">
      <location width="8"/>
      <labl>
        Is there an evidence of VL5 blood test request documented on chart?
      </labl>
      <valrng>
        <range UNITS="REAL" min="1" max="2"/>
      </valrng>
      <sumStat type="vald">
        2
      </sumStat>
      <sumStat type="invd">
        4198
      </sumStat>
      <catgry>
        <catValu>
          1
        </catValu>
        <labl>
          Yes
        </labl>
        <catStat type="freq">
          2
        </catStat>
      </catgry>
      <catgry>
        <catValu>
          2
        </catValu>
        <labl>
          No
        </labl>
        <catStat type="freq">
          0
        </catStat>
      </catgry>
      <catgry missing="Y">
        <catValu>
          Sysmiss
        </catValu>
        <catStat type="freq">
          4198
        </catStat>
      </catgry>
      <varFormat type="numeric" schema="other"/>
    </var>
    <var ID="V223" name="dqc_vl5date" files="F6" intrvl="discrete">
      <location width="11"/>
      <labl>
        Date of VL5:
      </labl>
      <sumStat type="vald">
        2
      </sumStat>
      <sumStat type="min">
        2022-03-25
      </sumStat>
      <sumStat type="max">
        2023-06-20
      </sumStat>
      <varFormat type="character" formatname="Nesstar.date" schema="other" category="date"/>
    </var>
    <var ID="V224" name="dqc_vl5resultavailable" files="F6" dcml="0" intrvl="discrete">
      <location width="8"/>
      <labl>
        Is VL5 result written in the chart?
      </labl>
      <valrng>
        <range UNITS="REAL" min="1" max="2"/>
      </valrng>
      <sumStat type="vald">
        2
      </sumStat>
      <sumStat type="invd">
        4198
      </sumStat>
      <catgry>
        <catValu>
          1
        </catValu>
        <labl>
          Yes
        </labl>
        <catStat type="freq">
          0
        </catStat>
      </catgry>
      <catgry>
        <catValu>
          2
        </catValu>
        <labl>
          No
        </labl>
        <catStat type="freq">
          2
        </catStat>
      </catgry>
      <catgry missing="Y">
        <catValu>
          Sysmiss
        </catValu>
        <catStat type="freq">
          4198
        </catStat>
      </catgry>
      <varFormat type="numeric" schema="other"/>
    </var>
    <var ID="V225" name="dqc_vl5results" files="F6" dcml="0" intrvl="contin">
      <location width="12"/>
      <labl>
        What is the result of VL5?
      </labl>
      <valrng>
        <range UNITS="REAL" min="141" max="385000"/>
      </valrng>
      <sumStat type="vald">
        2
      </sumStat>
      <sumStat type="invd">
        4198
      </sumStat>
      <sumStat type="min">
        141
      </sumStat>
      <sumStat type="max">
        385000
      </sumStat>
      <sumStat type="mean">
        192570.5
      </sumStat>
      <sumStat type="stdev">
        272136.409
      </sumStat>
      <varFormat type="numeric" schema="other"/>
    </var>
    <var ID="V226" name="dqc_vl5labcopy" files="F6" dcml="0" intrvl="discrete">
      <location width="8"/>
      <labl>
        Lab copy of VL5 filed in chart:
      </labl>
      <valrng>
        <range UNITS="REAL" min="1" max="2"/>
      </valrng>
      <sumStat type="vald">
        2
      </sumStat>
      <sumStat type="invd">
        4198
      </sumStat>
      <catgry>
        <catValu>
          1
        </catValu>
        <labl>
          Yes
        </labl>
        <catStat type="freq">
          2
        </catStat>
      </catgry>
      <catgry>
        <catValu>
          2
        </catValu>
        <labl>
          No
        </labl>
        <catStat type="freq">
          0
        </catStat>
      </catgry>
      <catgry missing="Y">
        <catValu>
          Sysmiss
        </catValu>
        <catStat type="freq">
          4198
        </catStat>
      </catgry>
      <varFormat type="numeric" schema="other"/>
    </var>
    <var ID="V227" name="data_extraction_ques_v_1" files="F6" dcml="0" intrvl="discrete">
      <location width="10"/>
      <labl>
        Complete?
      </labl>
      <valrng>
        <range UNITS="REAL" min="0" max="2"/>
      </valrng>
      <sumStat type="vald">
        4200
      </sumStat>
      <sumStat type="invd">
        0
      </sumStat>
      <catgry>
        <catValu>
          0
        </catValu>
        <labl>
          Incomplete
        </labl>
        <catStat type="freq">
          0
        </catStat>
      </catgry>
      <catgry>
        <catValu>
          1
        </catValu>
        <labl>
          Unverified
        </labl>
        <catStat type="freq">
          0
        </catStat>
      </catgry>
      <catgry>
        <catValu>
          2
        </catValu>
        <labl>
          Complete
        </labl>
        <catStat type="freq">
          4200
        </catStat>
      </catgry>
      <varFormat type="numeric" schema="other"/>
    </var>
  </dataDscr>
</codeBook>
